Healthcare Provider Details

I. General information

NPI: 1700040359
Provider Name (Legal Business Name): TLC HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

R 401 N HAPPY VALLEY RD
CARLSBAD NM
88220-8822
US

IV. Provider business mailing address

1022 S BISHOP
ROLLA MO
65401-5337
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-9199
  • Fax: 575-628-0029
Mailing address:
  • Phone: 575-706-7241
  • Fax: 573-341-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2006023875
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3310
License Number StateNM

VIII. Authorized Official

Name: TERRY GAIL BRATCHER
Title or Position: ADMINISTRATOR/OWNER
Credential: RN
Phone: 575-885-9199